The peer work program at Northern Sydney Local Health District (NSLHD) started 23 years ago on the back of consumer volunteers who were contributing significant time and expertise. Andrea Taylor, Director of Mental Health Drugs and Alcohol, remembers the organisation embraced the opportunity to offer a paid position: ‘It felt like a natural evolution’, she says.

There were teething problems. Community teams at the time had a strong ‘us and them’ culture and did not like the consumer workforce participating in meetings. Some staff left. Others found they had to change their language.

It can be exhausting to shift your thinking and your words. But the new language began to flow through the system and, Kate says, clinical staff began to see ‘a positive shift in their practice and outcomes across the board. So they could see a lot of value in it’.

Engaging a workforce living with mental illness also had initial challenges, most of which have been resolved over time. Consumer workers now work under the same rules as other staff, although they sometimes need greater flexibility around sick leave.

Funding has been a chronic problem since the first consumer position – four hours a week – was created all those years ago. Funding bodies don’t see consumer work as core business, and transferring money across awards and professions takes significant negotiation.

‘You’re trying to convince the management accountants … they just find it perplexing and puzzling. And the humanity within them will generally understand and come on board, but the numbers part of them struggles’, explains Kate.

A key issue is accountability. The consumer workforce doesn’t contribute to medical records or engage with the standard measures of outcome data. Kate wants to change this, but it’s a complicated task. Writing in medical records takes training and some peer workers don’t want to see the case notes, fearing they might influence their approach.

Meanwhile Kate has set up an internal system which captures peer worker activity monthly – things like how many people peer workers see and talk to, how many issues they resolve, the numbers attending recovery groups and the topics covered. She pulls it together in an annual report, but not being part of a formal system, it is not considered at the funding level.

If the challenges are significant though, the rewards are profound. Peer workers provide aspirational leadership and hope, notes Kate – ‘you were in same position, you’ve got an apartment, a dog, whatever, that stuff. You got a job, I want a job’. They also help NSLHD to meet their KPIs for social inclusion and activities within adult mental health services. A peer run phone line out of Hornsby Hospital maintains connections with people when they are most at risk.

There’s a ton of individual stories too. Kate remembers a patient in intensive care who became extremely agitated when he needed an injection. The clinical staff was unable to calm him down, so the doctor started writing up a PRN and ordering restraints. Peter, a peer worker, talked to him. The patient, a big, tough guy, could not admit it to the doctor and nurses but he was terrified of needles and needed someone to hold his hand. Once he told Pete, the situation was quickly sorted. ‘That’s a massive ROI for everybody’, says Kate.

NSLHD also use peer workers in its heat wave risk management plan for people on psychotropic medicines. Prior to the plan, people were dying, unaware that the medication impaired the ability of their body to feel heat. Now if it’s hot, consumer workers ring around to check in, provide information and offer places to go. They encourage people to keep hydrated and set up movie days in air-conditioned group rooms. Since the service started, no one has died from overheating.

The positive impact of consumer workers on services make the NSLHD determined to keep expanding the size and scope of peer roles, as it moves to a recovery-oriented culture. They’re always looking for new opportunities. So when a gardener resigned, they employed a peer work gardener to do gardening groups. ‘Eventually we transitioned that to be proper peer worker hours’, says Kate.

NSLHD wants to increase the scope of the peer support discharge program, and believe peer workers are the perfect people to help with wellness plans. They would like a casual workforce to fill in gaps when people are away. They are starting to employ peer workers in their child and youth mental health services and hope to introduce a drug and alcohol peer service too. Peer workers sometimes participate in staff interviews, and they contribute to the staff orientation programs of everyone from clinicians to cleaners. But it is a small workforce with huge demands on its time, so there’s a need to be selective.

‘We need a magic bucket of money to appear and a framework that says for every 100 people in your community you will have one full time equivalent peer worker. And then we get that and we are funded to provide that. And that would change everything’, says Kate.

Acknowledgements

The content of this resource was informed by research conducted by Leanne Craze of Craze Lateral Solutions and in consultation with peer workers. All photos and videos are reproduced here with permission.